Australian Society of Cytology

Case of the Month

August 2002 - Answer and Discussion

Cervical Tuberculosis

The cytology shows evidence of granulomas with epithelioid cells showing characteristic "footprint" nuclei. A multinucleated giant cell with peripherally located nuclei suggestive of Langhan's giant cell is also observed. These appearances, in conjunction with the clinical findings, raise the possibility of tuberculosis.

The cervical biopsy, taken at colposcopy, shows granulomas and Langhan's giant cells consistent with Tuberculosis.

Microbiology were able to culture Mycobacterium bovis.
Her chest Xray was normal but an abdominal Xray showed adrenal calcification, probably from previous TB.

She was treated with Rifampicin, Ionazid and Pyrazinamide for 18 months and was well with no symptoms for some years after.

Genital tuberculosis is rare in Australia and most developed nations. It is however quite common in many regions, including much of Asia. This patient was a migrant from Vietnam, highlighting the need to keep an open mind to all diagnostic possibilities.

The usual symptoms are:

Menstrual disorders
Blood stained vaginal discharge, post coital bleeding
Pelvic pain
Abdominal distention, ascites
Infertility

Genital tuberculosis is almost always secondary to a focus somewhere else in the body. The primary focus is often healed or dormant at the time the genital lesion becomes evident. This is seen in this case with the adrenal calcification indicating the probable primary site. It is often described as a 'silent disease' with 10 - 20 years of symptomless disease before the genital lesion becomes evident. Often investigation for infertility uncovers otherwise symptomless disease.

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